超声引导下腰脊神经后支松解治疗小关节源性腰痛的对比研究  

Clinical observation of ultrasound-guided neurolysis of posterior ramus of lumbar spinal nerve on patients with facet-joint-related lumbar pain

作　　者：童胜雄[1] 冯丹[1] 李少军 李敏[1] 张书力[1] 胡焓[1] 袁峰[1] 迮仁浩 Tong Shengxiong;Feng Dan;Li Shaojun;Li Min;Zhang Shuli;Hu Han;Yuan Feng;Ze Renhao(Department of Pain Management,Wuhan No.1 Hospital,Wuhan 430022,China;Department of Orthopedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]武汉市第一医院疼痛科,武汉430022 [2]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中华实验外科杂志》2023年第4期762-765,共4页Chinese Journal of Experimental Surgery

基　　金：武汉市卫生计生委科研项目(WX17D04)。

摘　　要：目的观察超声引导下腰脊神经后支松解治疗小关节源性腰痛的有效性及安全性。方法分析2019年9月至2021年9月在武汉市第一医院疼痛科治疗的120例腰椎小关节源性疼痛患者的临床资料。所纳入研究患者随机数字表法分为两组,各60例,超声引导下松解组(n=60)和数字减影血管造影技术(DSA)引导下松解组(n=60)。两组分别在超声及DSA引导下采用一次性硬膜外穿刺包中硬膜外穿刺针钝性分离松解腰脊神经后支。采用视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)进行治疗前及治疗后1周、1个月及6个月时患者疼痛评分和患者腰椎功能评分。结果治疗前两组VAS评分[(5.9±0.8)分比(6.0±0.9)分,F=1.161,P>0.05]和ODI评分差异均无统计学意义[(72.2±5.8)分比(73.3±6.8)分,F=1.022,P>0.05];与治疗前比较,两组在治疗后6个月时,VAS评分[(5.9±0.8)分比(1.9±1.3)分,F=20.182,P<0.01;(6.0±0.9)分比(1.6±1.2)分,F=15.654,P<0.01]和ODI评分明显降低[(72.2±5.8)分比(37.1±10.0)分,F=20.643,P<0.01;(73.3±6.8)分比(38.0±10.6)分,F=8.734,P<0.01],差异有统计学意义。治疗后1周、1个月和6个月,两组患者VAS评分[(2.2±1.0)分比(2.5±1.4)分,F=9.923,P>0.05;2.0±1.3)分比(2.1±1.3)分,F=0.110,P>0.05;1.9±1.3)分比(1.6±1.2)分,F=0.047,P>0.05]和ODI评分比较[(44.9±5.1)分比(45.5±5.2)分,F=0.000,P>0.05;38.0±10.6)分比(40.8±9.4)分,F=0.933,P>0.05;37.1±10.0)分比(38.0±10.6)分,F=0.001,P>0.05],差异无统计学意义;治疗后1周、1周、1个月和6个月超声引导组和DSA引导组临床有效率间差异无统计学意义(83.3%比75.0%,χ^(2)=1.263,P>0.05;91.7%比80.0%,χ^(2)=3.358,P>0.05;86.7%比78.3%,χ^(2)=1.143,P>0.05)。但超声引导组的穿刺时间,穿刺次数及手术时间明显低于DSA引导组[(20.2±6.7)min比(26.1±6.0)min,F=1.035,P<0.001;(2.7±1.4)次比(4.4±1.3)次,F=0.448,P<0.001;(34.1±8.3)min比(47.0±6.0)min,F=7.861,P<0.001]。此外,两组患者术中、术后均未发生不良反应。结�Objective To investigate the safety and efficacy of ultrasound-guided neurolysis of posterior ramus of lumbar spinal nerve on patients with facet-joint-related lumbar pain.Methods A total of 120 patients with low back pain were enrolled in this study from September 2019 to September 2021,in Wuhan No.1 Hospital.All the patients were randomly divided into 2 groups:ultrasound-guided group(n=60)and digital subtraction angiography(DSA)-guided group(n=60).In the two neurolysis groups,an epidural needle in disposable epidural anaesthesia puncture kit was used for neurolysis of posterior ramus of lumbar spinal nerve.Visual analogue scale(VAS)and Oswestry disability index(ODI)were used to assess pain control and lumbar function before therapy,and at 1st week,1st month and 6th month after treatment.Chi-square test was used for counting data,and t-test or Mann-whitney U test was used for measuring data.Results There was no significant difference in VAS scores(5.9±0.8 vs.6.0±0.9,F=1.161,P>0.05)and ODI(72.2±5.8 vs.73.3±6.8,F=1.022,P>0.05)between the two groups before treatment.The VAS scores(2.2±1.0 vs.2.5±1.4,F=9.923,P>0.05;2.0±1.3 vs.2.1±1.3,F=0.110,P>0.05;1.9±1.3 vs.1.6±1.2,F=0.047,P>0.05)and ODI(44.9±5.1 vs.45.5±5.2,F=0.000,P>0.05;38.0±10.6 vs.40.8±9.4,F=0.933,P>0.05;7.1±10.0 vs.38.0±10.6,F=0.001,P>0.05)were significantly reduced in both groups at 1st week,1st month,and 6th month.At 1st week,1st month and 6th month after treatment,83.3%,91.7%,86.7%patients in the ultrasound-guided group and 75.0%,80.0%,78.3%patients in the DSA-guided group achieved good outcome(83.3%vs.75.0%,χ^(2)=1.263,P>0.05;91.7%vs.80.0%,χ^(2)=3.358,P>0.05;86.7%vs.78.3%,χ^(2)=1.143,P>0.05).The operating time in the ultrasound-guided group was significantly shorter[(20.2±6.7)min vs.(26.1±6.0)min,F=1.035,P<0.001;2.7±1.4 vs.4.4±1.3,F=0.448,P<0.001;(34.1±8.3)min vs.(47.0±6.0)min,F=7.861,P<0.001).No complication was found in both groups.Conclusion Ultrasound-guided neurolysis of posterior ramus of lumbar spinal nerve can effectively

关 键 词：小关节源性腰痛 脊神经后支 神经松解治疗 超声引导 

分 类 号：R681.53[医药卫生—骨科学]